Medicare_Carriers_Manual / 7207 / 7207

Why This Topic Matters

Readers use this guidance to understand the administrative requirements and supporting documentation expected in deceased-beneficiary underpayment cases. It is especially relevant when more than one party may be entitled to payment or when the bill was not fully satisfied before death.

Article Sections

1. 7207. General Requirements

   Covers the main administrative requirements for processing underpayment claims involving a deceased beneficiary. The section addresses claim filing, evidence of payment, evidence that services were rendered, multiple payees, and partially paid bills.

2. A. Filing of Claim

   Discusses the basic claim-filing requirements and the documentation expected when a claim was or was not filed before death.

3. B. Evidence of Payment

   Describes the types of documentation used to show that a bill was paid and identify the payer.

4. C. Evidence of Services Rendered Where Bill Not Paid By Beneficiary Before Death

   Explains when additional substantiation may be needed to show that services were actually furnished to the decedent enrollee.

5. D. Multiple Payees

   Addresses situations where more than one person may share in the payment and how the payment may be allocated among entitled parties.

6. E. Partially Paid Bill

   Covers handling of claims when only part of a medical bill was paid before the beneficiary’s death and further action may be needed for the unpaid portion.